=====================================================
General NPI Number Information
=====================================================
NPI Number | 1902789787
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FORT PECK TRIBES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/29/2025
-----------------------------------------------------
Last Update Date | 07/29/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 550 6TH AVE N
-----------------------------------------------------
City | WOLF POINT
-----------------------------------------------------
State | MT
-----------------------------------------------------
Zip | 59201-6000
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 406-768-5790
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1027
-----------------------------------------------------
City | POPLAR
-----------------------------------------------------
State | MT
-----------------------------------------------------
Zip | 59255-1027
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 406-768-5790
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | TRIBAL SERVICE UNIT DIRECTOR
-----------------------------------------------------
Name | DENNIS FOUR BEAR
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 406-768-5790
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332800000X
-----------------------------------------------------
Taxonomy Name | Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------